Rural Areas Are Less Healthy Than Suburbs, Says Report

The first set of reports ever produced to provide comparative health data for all 3,000-plus counties in all 50 states was released Wednesday by the Robert Wood Johnson Foundation and University of Wisconsin's Population Health Institute.

The 50-state reports are designed to help public health and community leaders, policymakers, consumers, and others to understand the health of their counties—compared with others within their state—and find ways to improve the overall health of their population.

"We view the country health rankings as an important companion to America's health rankings," said Risa Lavizzo Mourey, MD, president and CEO of the Robert Wood Johnson Foundation at a briefing in Washington, DC. The rankings are important because "they tell us a story about the factors that influence how healthy we are and how long we live," she added.

"They tell us that health depends on more than healthcare, and they tell us health happens in our communities—where we live, learn, work, and play," she said. The rankings are "an important tool in helping to pinpoint health problems—which means more of a likelihood of solving problems."

The foundation worked with the University of Wisconsin to develop a "robust Web site." The Web site provides comparisons on health factors related to health behaviors, clinical care, social and economic factors, and physical environment. The rankings will be used to mark progress over time. "We believe this is a new chapter in our nation's health," she said.

For the first time, people have a tool "to help identify what is making people in every county unhealthy," said Patrick Remington, MD, associate dean for public health at the University of Wisconsin School of Medicine and Public Health. Wisconsin first looked at the variations in healthcare by county beginning in 2003.

"We hope this kind of check up will mobilize community leaders to take action and invest in programs and policy changes that make their counties healthier places to live," he said.

Close attention is paid to morbidity and mortality rates in the counties—how healthy they are and how long they lived. In particular, researchers used five measures to assess the level of overall health or health outcomes by county:

• The rate of people dying before age 75
• The percentage of people who reported being in fair or poor health
• The number of days people reported being in poor physical health
• The number of days in poor mental health
• The rate of low birth weight infants

The counties also were ranked on key factors that affect health, such as: smoking, obesity, binge drinking, access to primary care providers, rates of high school graduation, rates of violent crime, air pollution levels, liquor store density, unemployment rates, and number of children living in poverty.

More than 80% of the less healthy areas were found in small or rural areas of the states. Only 2% of the least healthy communities were in suburbs, Remington said.

Among the reported findings among the counties are:

• Premature death rates. The least healthy counties have significantly higher rates of premature death—some are 2.5 times higher than the healthiest counties.
• Self reported health. People living in the least healthy counties reported being in significantly poorer health—2.1 times higher rates of people who report being in fair or poor health, compared with the healthiest counties.
• Smoking rates. People living in the least healthy counties are much more likely to smoke—more than 26%, compared to only 16% in the healthiest counties.
• Preventable hospitalizations. People living in the least healthy counties are 60% more likely to be admitted to the hospital for preventable conditions—a sign of poor outpatient and primary care.
• Children living in poverty. The least healthy counties have higher rates of poverty, with 30% of children living in poverty—more tan three times higher than the rate in the healthiest counties (9%).
• Access to healthy foods. The 50 least healthy counties have fewer places where people can find healthy food—only 33% of zip codes have at least one grocery store, compared to almost half (47%) of zip codes in the healthiest counties.

Sometimes, a county's rank could show a pattern of strengths and weaknesses, Remington said. For instance, Woods County, OK, ranked first in the state for overall health, but ranked 48th out of 77 on clinical care access and quality.

Meanwhile, Carbon County, MT, ranked second in the state for overall health, but ranked 39th out of 44 on factors related to the physical environment, such as air pollution, access to healthy foods, and liquor store density.